medwireNews: A large survey has uncovered a number of issues that particularly frustrate people with diabetes during their interactions with their healthcare providers.
These include providers having a poor understanding of how it is to live with diabetes, giving generic advice, and not fully appreciating the person’s own expertise in their diabetes.
“The diverse and large numbers of unmet wishes indicate that the person with diabetes does not always perceive themselves to be at the centre of their diabetes care,” say the researchers.
The findings come from the responses of 1190 Australian people with diabetes who completed the MILES-2 survey, of whom 646 (average age 44 years) had type 1 diabetes and 544 (average age 61 years) had type 2 diabetes, with 43% of the latter being insulin dependent.
Elizabeth Holmes-Truscott (Deakin University, Geelong, Victoria, Australia) and co-researchers stress that such a “large and diverse” study population is “rarely seen for a qualitative study,” although they caution that respondents tended to be of higher socioeconomic status than the general Australian population.
“It could well be that the unmet needs of those who did not take part, particularly more vulnerable groups such as those with lower socio-economic status and education levels, might be greater and different from those of the respondents,” they write in Diabetic Medicine.
From the responses of the people who did take part, the team identified several main areas where they wished for greater knowledge or different behavior from their healthcare providers, including:
- The respondents often felt that their healthcare providers had an incomplete understanding of the barriers they faced when managing their diabetes, such as comorbidities, treatment side effects, and access to healthcare.
- They also wished healthcare professionals had more insight into how difficult it can be to put recommendations into practice, especially in the face of competing demands such as family, work, and participating in social engagements.
- Related to this was the feeling that healthcare professionals often failed to appreciate the impact that diabetes had on their social interactions and emotional state, the latter including diabetes burnout and fear of hypoglycemia, particularly nocturnal hypoglycemia, and other complications.
- Respondents expressed frustration at being given very generic advice, especially lifestyle advice, without any attempt to tailor it to the individual, discuss alternative options, or to provide “instructive support” to help them put advice into practice.
“Some reported general dissatisfaction with care and even disengagement with care because of their negative experiences,” say the researchers.
Survey respondents also felt that healthcare providers were prone to putting too much focus on glycemic targets, and failed to take a whole-person approach to diabetes care. Finally, they combined a feeling that their healthcare providers were often insufficiently well versed in diabetes with a wish that their own expertise in their condition be more fully appreciated.
But Holmes-Truscott and team stress that a third of the study participants described very positive healthcare experiences, implying that “many of these needs can be met and depend largely on the health professional’s training and attitude.”
They conclude: “Based on the present findings, many of the wishes raised by the respondents could be met by ‘upskilling’ health professionals in diabetes-related knowledge, and enhancing their competences in empathic and person-centred care.”
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Diabet Med 2019; doi:10.1111/dme.14199